CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopa…
55 yoF h/o HTN presents BIBEMS with acute onset decreased level of consciousness, onset 3 hours prior to arrival. BP 220/140 HR 50 T 98.0 RR 10 SPO2 92%. Pt is obtunded, no localizing neuro findings. Pt intubated for airway protection. CT s…
In the ED we often provide first line care for patients as the result of traumatic events. Beyond attending to clinically apparent injuries, pain, and distress, we would be in a position to apply prophylactic treatment to attempt to preven…
A 75M presents with several days of cough, fever, and progressive lethargy. CXR demonstrates RLL pneumonia. BP 70/50. HR 130. Lactate 5. T38.0 2L bolus NS given. Antibiotics started. Bedside sono shows noncollapsing IVC, hyperdynamic LV. Re…
A 55M h/o HTN presents with 5 hours of palpitations that woke him from sleep. His complaint is that the sensation of his fast beating heart is uncomfortable. There is no chest pain, no SOB. There are no other associated symptoms. Vitals: HR…
Pt is 54 yo M with PMH of DM, HTN, Crohn Disease presents with 2 days of worsening vomiting, had diarrhea initially that has now stopped and is no longer passing gas, also reports some slight abdominal distention. Patient has had several ab…
Patient is 49 yo F who presents to ED with few days of fever (T max 102F), progressive headache, neck stiffness. Patient denies any travel, rashes, sick contacts. Pt complains she can’t be in a well lit room or go outside without pain…
Pt is 58 yo M with PMH of alcoholism, HCV with liver cirrhosis (h/o variceal GI bleeds, h/o SBP, h/o hepatic encephalopathy) presents to ED with 2-3 days of altered mental status and fever, you want to rule-out Spontaneous Bacterial Periton…
“Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients wit Allergic Reactions or Anaphylaxis” Grunau BE, Li J, Yi TW, et al. Annals of Emergency Medicine 2014; 63(6): 736-744 Background: Al…
Appendicitis on ultrasound – the first step is to identify the appendix by finding a blind-ending tubular structure arising from the base of the cecum. The sonographic signs of appendicitis include: dilated…
Quantitative D-dimer is a common screening tool to rule-out pulmonary embolism in low-risk population but is there more that it can tell us? Yes, there have been studies linking increasing d-dimers to: 1) likelihood of PE, 2) locatio…
Thirsty (for knowledge) Thursday Patient is 72 yo F wtih PMH of HTN, severe aortic stenosis presented to ED with dizziness and shortness of breath, progressively worse over the last 2 weeks, both symptoms worse with exertion. Patient…
Tox Tuesday Patient is 42 yo M with PMH of chronic back pain (follows in pain clinic), depression BIBEMS found after wife found him with an apparent overdose attempt with an empty bottle of Tramadol next to him, last seen in USOH 4 hr prio…
Microbio Monday CASE 42 yo F, previously healthy, presents to ED with 4-5 days of fever, chills, nonproductive cough followed by muscle aches. Symptoms are getting worse and have not responded to OTC treatments. Patient presented tod…
Tenosynovitis = inflammation of a tendon and its sheath. Most acute cases of flexor tenosynovitis (FT) are infectious but may also be secondary to inflammation from noninfectious cause (e.g. diabetes, overuse, arthritis) Infectious tenosyn…
